Lack of Awareness of Cognitive Issues Presages Alzheimer’s Disease Interview with:
Joseph Therriault

Integrative Program in Neuroscience What is the background for this study? What are the main findings? 

Response: Neurologists have known for a long time that Anosognosia, or unawareness of illness, appears in individuals with Alzheimer’s disease. For example, these patients will have diminished awareness of their memory loss, and will also engage in dangerous behaviors, such as leaving the house to go for a walk, without knowing they are at high risk of getting lost.

However, it was not known if decreased awareness of cognitive problems existed in the pre-dementia phase of Alzheimer’s disease. In our study, we compared the ratings of cognitive decline from the patient and their close relative, who also filled out the same questionnaire. When a patient reported having no cognitive problems but the family member reported significant difficulties, the patient was considered to have poor awareness of illness.

We found that patients who are less aware had increased disease pathology, and were nearly three times as likely to progress to dementia within two years, even when taking into account other factors like genetic risk, age, gender and education. The increased progression to dementia was mirrored by increased brain metabolic dysfunction in regions vulnerable to Alzheimer’s disease. What should readers take away from your report? 

Response: This has practical applications for clinicians: people with mild memory complaints should have an assessment that takes into account information gathered from reliable informants, such as family members or close friends. What recommendations do you have for future research as a result of this work?

Response: Future work should explore the best way to assess lack of awareness of illness across the Alzheimer’s disease spectrum. This will help with the validity of future clinical assessments of illness awareness in patients with memory complaints. Is there anything else you would like to add? 

Response: This study was made possible by open science initiatives. We would like to thank the Alzheimer’s Disease Neuroimaging Initiative for sharing their high-quality data with researchers from the world. Our work is a great example of how open science can have a tangible impact on patient care.

Thank you very much for your interest in our study.


Joseph Therriault, Kok Pin Ng, Tharick A. Pascoal, Sulantha Mathotaarachchi, Min Su Kang, Hanne Struyfs, Monica Shin, Andrea L. Benedet, Ishan C. Walpola, Vasavan Nair, Serge Gauthier, Pedro Rosa-Neto. Anosognosia predicts default mode network hypometabolism and clinical progression to dementia. Neurology, 2018; 

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Last Updated on February 16, 2018 by Marie Benz MD FAAD